Ch. 5 The Physician-Patient Relationship

Question 1

Physician-Patient Relationship

Answer 1

• Both must agree to form relationship for there to be contract for services (implied contract)
• Under contract for services, patient can expect doctor to provide medical service for as lone as necessary
• Patient must confide truthfully to physician
  - Physician is not liable if critical information withheld
• Patient information is confidential
  - Includes overheard or read

Question 2

Physician’s Rights

Answer 2

• Right to select patients
• Right to refuse service to patients
• Right to determine type of services provided
• Right to be paid for services rendered
• Right to withdraw from relationship
• Right to vacation and time off

Question 3

Physician’s Responsibilities

Answer 3

• Be professionally competent
• Treat all patients equally
• Not to take “kickbacks” of money or other benefits in exchange for referrals
• Follow AMA code of ethics

Question 4

Physicians’ Duties

Answer 4

• Patient welfare above financial interests
• Professional courtesy
• Report any unethical conduct by other physicians
• Recommend second opinions when necessary
• Do not engage in sexual conduct with a patient during the physician-patient relationship
• Do not treat family members except in emergencies

Question 5

Professional practice duties during a medical emergency

Answer 5

• Cannot ethically or legally turn away patient in an emergency situation
• If unable to treat patient, then must call for emergency assistance
• Patients cannot be turned away if indigent or uninsured

Question 6

Duty to Treat Indigent Patients

Answer 6

• “Dumping crisis”
  - EMTALA— Requires hospitals to stabilize a patient during an emergency situation
  - Require patient stabilization in an emergency
• Physician has right to select which patients to treat
• Physician does not have right to drop or abandon patients once treatment is agreed upon

Question 7

Duty Not to Abandon a Patient

Answer 7

• Once physician agrees to take care of patient, contract may not be improperly terminated
• Physician may be charged with abandonment if formal notice of withdrawal is not given
  - Civil wrong, or tort
• Physician must allow patient time to seek service of another physician
• Licensed health care providers are also subject to this principle
  - Dentists
  - Physician assistants
  - Nurse practitioner

Question 8

Noncompliant

Answer 8

• Fails or refuses to cooperate

Question 9

Incompetent

Answer 9

• Unable to provide for own needs
• Status decided by court of law

Question 10

Duty to Treat Patients with AIDS

Answer 10

• Unethical to refuse to treat, work with, or provide housing for person who is HIV positive or has AIDS
• Physician, by law, must make full report to state about any patient who is HIV positive or has AIDS
  - Ethical dilemma
  - Report required regardless of consequence
• Ethical considerations
  - Persuade patient to inform his or her partner
  - Notify authorities if concerned that patient will not inform others
  - As last resort, notify patients partner

Question 11

Exposure of Health Care Workers to Patient’s Blood

Answer 11

• At 0.3 percent risk of contracting HIV after blood exposure, according to the CDC
• HIV testing of patient’s blood allowed in some states

Question 12

Restrictions on HIV-Infected Health Care Workers

Answer 12

• Various recommendations, but not rules
  - AMA
  - American Academy of Orthopedic Surgeons
  - Federation of State Medical Boards
  - Strongest statement
  - Recommends names of HIV-infected health care workers be reported

    - CDC
          - Testing all health care workers would be prohibitive
          - No ethical duty to disclose HIV status if no significant risk presented to patients

Question 13

Duty to Properly Identify Patients

Answer 13

• Identify patient both by stating his or her name and examining any other identification
  - Medical wrist band
  - Driver’s license
  - Use discretion with patient sign-in sheets to protect confidentiality
  - Have patient state name

Question 14

Duty to Respect Confidentiality

Answer 14

• Speak in low voice
• Glass enclosure should separate front desk receptionist from waiting room
• Sign-in sheet should consider protection from subsequent patients

Question 15

Duty to Tell the Truth

Answer 15

• Many believe principles of justice apply when dealing with truth-telling
• Try to determine the “just” action for patient
• Just action may be at variance with obligation of confidentiality
• Confidentiality may be overridden when life or safety of patient is endangered

Question 16

Patient’s Rights

Answer 16

• Right to confidentiality
  - Privileged communication
• Right to give informed consent
• Right to privacy
• Right to be informed of advantages and potential risks of treatment
• Right to refuse treatment

Question 17

Confidentiality

Answer 17

• All information and records about treatment will be kept confidential by physician and staff unless consent to release is obtained
  - Breach of confidentiality is both unethical and illegal
• Medical Patients Rights Act
  - All patients are entitled to have privacy respected and medical records handled confidentiality
• Privileged communication
  - Confidential information told to a physician or attorney by a patient
• HIPAA regulations must be observed (Ch. 10)

Question 18

Patient Self-Determination Acts

Answer 18

• Advance directive
  - Living will
  - “Do Not Resuscitate” order

    - Durable power of attorney
    - Uniform Anatomical Gift Act

• Patient may revoke these documents
• Family may consent on the deceased patient’s behalf

Question 19

Minor

Answer 19

• Person under the age of maturity (18 is most states)

Question 20

In loco parentis

Answer 20

• Person assigned by court to stand in place of parents

Question 21

Parents patriae

Answer 21

• State takes over care for minor

Question 22

Mature minor

Answer 22

• Person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent

Question 23

Emancipated minor

Answer 23

• Person in mid to late teens who legally lives outside parents’ or guardian’s control
• Proof should be included in medical record

Question 24

The Patient’s Responsibilities

Answer 24

• Follow physician’s instructions
• Make follow-up appointments and monitor treatment and medication use if requested by physicians
• Be honest
• Pay for medical services
• Provide informed consent

Question 25

Consent

Answer 25

• Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment
• Two types
  - Informed (expressed) consent
  - Implied consent

Question 26

Informed or expressed consent

Answer 26

• Patient agrees to course of treatment after being told consequences of having or not having certain procedures and treatments
• Signature indicates patient understands limits and risks involved as explained by physician

Question 27

Doctrine of Informed Consent: Requires physician to explain in understandable language

Answer 27

• Diagnosis
• Nature of proposed treatment
• Advantages and risks or treatment
• Alternative treatments available to patient
• Potential outcomes of treatment
• What might occur-risks and benefits-if treatment is refused

Question 28

Implied Consent

Answer 28

• Patient indicates by behavior that he or she accepts procedure
  - Offers arm to have blood sample drawn
• Consent is assumed in medical emergencies

Question 29

Exceptions to Consent

Answer 29

• Need not inform of commonly known risks
• Need not inform if disclosure of risks may be detrimental to patient
• Need to inform if patient asks physician not to disclose risks
• Not required to restore patients to original health
• Cannot elicit cure for every patient
• Cannot guarantee successful results of every treatment

Question 30

Refusal to Grant Consent

Answer 30

• Adult patients conscious and mentally capable have right to refuse any medical or surgical treatment
• Refusal must be honored no matter what patient’s reasoning
• Failure to respect right of refusal could result in liability for assault and battery

Question 31

Role of Health Care Consumer

Answer 31

• Do not self-medicate
• Be honest with physician
• Assist physician in prevention of medical errors